CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Brookings Health System

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $158
Cash Discount Price: $152
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Brookings Health System is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.34x the Medicare baseline. Located in 300 22Nd Ave, Brookings, SD.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $152 (129%)

Insurance Median: $158 (134%)

Cash: $152 (129% of Medicare)

Ins. Median: $158 (134% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicare (plans)	$79 - $342	67%
Medicaid / KanCare	$95 - $342	81%
Sanford_Bhcag	$116 - $325	99%
Blue Cross Blue Shield	$128 - $342	109%
Avera	$131 - $308	111%
Medica_Msho	$134 - $137	114%
Medica	$137 - $250	117%
Medica_Accessibility_Solution	$137 - $250	117%
Medica_Choice_Care	$137	117%
Medica_Selectcare	$137 - $250	117%
UnitedHealthcare	$179 - $283	152%
Multiplan	$211 - $332	179%
Humana	$308	262%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $152.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Brookings Health System is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.